By Catherine Marschilok, M.S.N., C.D.E., Board Certified in Advanced Diabetes Management
Children with diabetes are using pump therapy in greater numbers than ever before. When students with diabetes make the leap from injection therapy to insulin pump therapy, everyone involved in their care–including school nurses and health staff members–must be prepared to make the leap with them. All adults responsible for the student with diabetes during the school day should have a basic understanding of how the pump works and when they may have to intervene or troubleshoot.
Handling Common Problems
Even with diligent self-care, pump problems can occur during the school day and may require the intervention of the school nurse or other school health personnel. The cannula (insertion tube) can accidentally fall out or get pulled out, or can become obstructed, interfering with insulin absorption. When a student has used more insulin than usual since the last site change, the pump can run out of insulin.
TO BE SAFE WITH INSULIN PUMP THERAPY IN SCHOOL, STUDENTS MUST:
- Check their blood sugar multiple times throughout the day
- Respond to blood sugar readings
- Receive help when blood sugar levels are low or high
- Never go to the nurse’s office or anywhere alone when they are experiencing high or low blood sugar episodes
If steady delivery of insulin is compromised, the blood sugar rises fast, and potentially dangerous high blood sugar symptoms escalate. Students must be able to respond quickly to any situation that interferes with steady delivery of insulin. They should either change the site in school, with help from a trained staff member, or they should take an injection of insulin to make up for missed basal doses.
Care Plans for the Student with a Pump
All students who use insulin pumps should have a healthcare plan that carefully spells out the responsibilities of the school staff, the level of self-direction capabilities of the student, emergency contact numbers, permission to administer glucagon, and an alternative plan for insulin delivery. The student’s insulin regimen should include current basal rates, bolus dose correction, target blood sugar, and bolus dose insulin-to-carbohydrate ratio. In the most current “smart pump” models, this information is programmed into the pump and the pump calculates the insulin dose.
School personnel have several options for obtaining training in insulin pump therapy: Diabetes educators and pump manufacturers often provide training for school staff. The back cover of most pumps lists a toll-free telephone number for technical assistance or for obtaining additional copies of user manuals from manufacturers. And most children who use insulin pumps live with adults who are very involved in their diabetes care and are trained in use of the pump.
Finally, remember that if you and your child are new to diabetes, it can take a lot of time, effort, and energy to climb up the learning curve. When you start down the pump path, you may “slip back” down the curve a bit before climbing confidently back up. Try to remember that you are in good company. Increasingly, people of all ages are benefiting from the positive changes pump therapy has made in their lives. If the going gets rough for you, reach out to the people who have been there and to the pump company’s clinical support staff. And be proud of your family and your school staff for taking the leap.
For more information about healthcare plans for schools (and sample plans), visit jdrf.org’s Type 1 Diabetes in School section.
TO ASSIST STUDENTS WITH DIABETES WHO USE PUMPS, SCHOOL HEALTH PERSONNEL SHOULD ACHIEVE TECHNICAL COMPETENCE WITH SIMPLE PUMP THERAPY TASKS, INCLUDING:
- Inserting the pump cannula
- Delivering bolus insulin through the pump
- Checking pump memory to see the time of the last bolus dose
- Troubleshooting to determine if there is a problem with the pump
- Replacing batteries
THE FOLLOWING BACK-UP SUPPLIES SHOULD BE AVAILABLE IN THE HEALTH OFFICE:
- Two infusion sets
- Two insulin reservoirs
- Insulin bottle
- Traditional syringe or insulin pen and pen needle
- Alcohol wipes
- A user manual for the pump the student uses
- A quick programming card
- Ketone strips
- Supplies for testing blood sugar
- A glucagon kit and glucose tablets
Catherine Marschilok wrote about “Smart Pumps” in the December 2005 issue of the JDRF Life with Diabetes E-Newsletter.